Through collaborative use of improvement science methods, reduce preterm births & improve

perinatal and preterm newborn outcomes in Ohio as quickly as possible.

Welcome! MOMS Plus ProjectApril Action Period Call

Ohio Perinatal Quality Collaborative April 19, 2019

Welcome to the OPQC MOMS Plus Action Period Webinar

~ PLEASE BE CERTAIN TO USE YOUR PARTICIPANT CODE!! ~

Please sign in the chat box with the names of all webinar participants AND your hospital/OB practice affiliation or organization.

Please be certain you are on “mute” when not speaking to avoid background noise. You can mute/unmute yourself by clicking the “Mute” icon at the bottom of the screen or by pressing *6 on your phone.

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Time Topic Presenter

12:00 pm Welcome & Agenda Review Susan Ford, MSN, RN

12:05 pm Key Driver Diagram Susan Ford

12:10 pm Checklists• Feedback from teams testing the checklist

Script to Consent Patient • Feedback from teams testing the script

Discussion/Q&A

Dave McKenna, MDOPQC Faculty Mentor

&Susan Ford

All teams

12:45 pm 2019 Systems InventoryRegional Meetings

Susan Ford

12:55 pm Next Steps Susan Ford

Agenda

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SMART Aim

Key Drivers Interventions

By June 30, 2019 we will:Optimize maternity medical home to improve outcomes for pregnant women with opioid use disorder (OUD) as measured by:

• Increased identification of pregnant women with OUD

• Increased % of women with OUD during pregnancy who receive prenatal care (PNC), Medication Assisted Treatment (MAT) and Behavioral Health (BH) counseling each month

• Decreased % of full-term infants with Neonatal Abstinence Syndrome (NAS) requiring pharmacological treatment

• Increased % of babies who go home with mother

Project Leader: Carole Lannon (PI)

Optimize the health and well-being of pregnant women with opioid use

disorder and their infants

Global Aim

Pregnant women withopioid use disorder

Population

Revision Date: 5/21/2018

MOMS+ ProjectKey Driver Diagram (KDD)

Timely identification and tracking of

pregnant women with opioid use disorders

Compassionate and coordinated care

Empowerment of women through

community based services

Supported mother/infant dyad

post delivery

• Complete a standardized screening tool on each patient to accurately identify and diagnose pregnant women with OUD (e.g. 5 P’s, NIDA Quick Screen).

• Establish a coordinated referral system with BH providers, MAT providers, drug courts, prisons, homeless shelters, and ERs.

• Utilize a tracking system (e.g.. Database, spreadsheet) to follow pregnant women with OUD history/diagnosis and all babies with prenatal opiate exposure.

• Check OARRS per prescribing protocols.

• Connect women to vocational training opportunities as applicable• Involve community partners including referrals to faith-based organizations to support

pregnant women with OUD (e.g. support groups, shelters, food pantries, etc.)

• Complete training in trauma informed care and addiction as a chronic illness to provide non-judgmental support for pregnant women with OUD

• Designate a care coordinator to arrange referrals and ongoing communication between the trans-disciplinary care team.

• Provide immediate support/counseling at time of identification by OB/FP by using standardized interviewing techniques.

• Implement a process to prevent acute opiate withdrawal by initiating MAT• Implement a standardized process for referral to appropriate/necessary resources for women

with a positive screen for OUD.• Coordinate care between OB, BH, MAT, NICU/Pediatrics by regularly reviewing shared

patients (e.g. multi-disciplinary care conference, huddle).• Tailor counseling and support for healthy behaviors based on patient-specific situation/need

during pregnancy (sobriety, smoking cessation, stable housing and birth spacing (LARC)), with referral to community resources as needed to augment medical resources.

• Consider implementing or referral to OUD specific Centering Pregnancy© program

• Coordinate Prenatal consultation for pregnant women with OUD with Neonatology/Pediatrics to discuss Neonatal Abstinence Syndrome (NAS)

• Ensure mom and baby have a Patient Centered Medical Home (post-delivery) • Provide a warm handoff to pediatric care provider for infant post discharge (e.g.

call/consultation and newborn/maternal summary)• Provide lactation consultation (if applicable), post partum depression screening and

contraceptive counseling• Prenatal referral for pregnant women with OUD to Community Health Workers and/or home

visitation programs (dependent on region)• Postnatal referral or consideration to Help Me Grow and/or parenting classes• Facilitate continuation and retention of OUD treatment and services during pregnancy and

post-delivery occur (e.g. support of ongoing MAT maintenance services, training care providers to recognize signs of relapse and that mom is continuing in her treatment program)

• Coordinate with Department of Job & Family Services/Child Protective Services regarding reporting requirements and infant plan of safe care

Testing of the OPQC Checklist for the Pregnant Patient with OUD

Testing of the script for consent of the patient’s data to be entered into the OPQC MOMS Plus Data Care

Coordination Registry6

Suggested PDSAs…• Checklist: Utilize the OPQC Draft Checklist on ONE patient and

provide feedback regarding content and benefit of use

• Script regarding OPQC Data Registry: test the script with ONE patient when obtaining 42 CFR consent and provide feedback

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Suggested Checklist to test

Adapted with permission from the ILPQC: http://www.ilpqc.org/?q=MNO-OB

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The importance of testing…

“…while checklists are an important tool for standardization, they must be tested and implemented correctly to be effective”.

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Testing the OPQC Checklist for the Pregnant Patient with OUD

Summa Health

Good Samaritan Hospital –HOPE Program

Miami Valley Hospital –Promise to Hope

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Discussion with patients regarding 42CFR consent for data registry entry

• We are so glad you have chosen to receive care for opiate use disorder during your pregnancy. This diagnosis is sensitive, and we want ensure you that we will do our best to protect your privacy and confidentiality.

• We are obligated to inform any patient who receives treatment for substance use disorder exactly who will have access to their patient information and for what purpose that information will be used. This obligation comes from federal law and the specific consent is called 42CFR.

• Your addiction medicine provider, obstetric provider, and behavioral health provider are participating in a statewide initiative to improve the care we provide for pregnant women with opiate use disorder. This program is being conducted by the Ohio Perinatal Quality collaborative (OPQC), in conjunction with the Ohio Department of Medicaid (ODM).

• Your addiction medicine provider, obstetric provider and behavioral health provider will be sharing information to take care of you day-to-day. Medicaid and OPQC will have access to data to help track outcomes for our patients in hopes of making larger-scale changes to improve the care of all pregnant women with opiate use disorder.

• By signing this form with our facility, you are consenting that:– Your information can be shared with your addiction medicine provider– Your information can be shared with your behavior health provider– Your information can be shared with the Ohio Perinatal Quality Collaborative (OPQC)– Your information can be shared with the Ohio Department of Medicaid (ODM)

• This information cannot be accessed by employers or legal entities without your consent. 12

Documentation of patient consent in the MOMS Plus Registry

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Discussions with the patient regarding consent to enter data

Adena Regional Medical CenterAtrium Medical Center

Miami Valley Hospital-Promise to Hope University Hospital Cleveland Medical Center

How did it go?

What questions did the patient have?

Was the script

helpful?

Did anyone decline consent after being asked?

What should be added;

what should be deleted?

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MOMS+ Systems Inventory - 2019• All OPQC MOMS Plus

teams took the Systems Inventory last year.

• A year later, what has changed from a site specific standpoint? Regional? Aggregate?

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2019 MOMS+ Regional Meetings

NE Region- June 3

Central Region- June 4

SW Region- May 30

NW Region- May 23

Dayton Region- May 22

Southeast OhioOhioHealth O’Bleness Hospital (Athens)Adena Regional (Ross)Southern Ohio Medical Center (Scioto)

West Central/DaytonMiami Valley Hospital (Montgomery)Atrium Medical Center (Warren) St. Rita’s (Allen)Southview Medical Center (Montgomery)Springfield Regional Hospital (Clark)

Northwest Ohio ProMedica Toledo Hospital (Lucas)Mercy St. Vincent Medical Center (Lucas) Blanchard Valley Hospital (Hancock)

Southwest OhioGood Samaritan (Hamilton) Bethesda North (Hamilton)UC Medical Center (Hamilton)The Christ Hospital (Hamilton)

Northeast OhioMetroHealth Medical Center (Cuyahoga) Akron General AxcessPointe (Summit)Akron Summa (Summit)Fairview Hospital/CCF (Cuyahoga)Hillcrest Hospital/CCF (Cuyahoga)St. Elizabeth Boardman (Mahoning)St. Joseph Warren (Trumbull)University Hospitals Cleveland (Cuyahoga)

Central OhioOhioHealth Grant (Franklin) OhioHealth Riverside Methodist (Franklin)OSU Wexner STEPP (Franklin)Genesis HealthCare System (Muskingum)Lower Lights FQHC (Franklin)

SE Region- May 14

NW Region- May 23

SW Region- May 30

NE Region- June 3

Participating Sites

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NAS Dyad Care Webinar

Please join OPQC on Tuesday, May 7th 3-4pm for an upcoming webinar to discuss maternal-infant dyad care in the context of opioid use.

Contact info@opqc.net to register

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Next StepsMOMS Plus Project

• The next MOMS+ Action Period Call will be Friday, June 21st at 12N– May 17th Action Period Call will be cancelled d/t the Regional Meetings

• Register for your Regional Meeting!

• Key Contacts: – Submit your team’s DUA and BAA documents if not yet done– Review/submit Monthly Progress Report; the April MPR will be sent out next week– Submit the Systems Inventory for your site if not yet completed! – Schedule your team’s coaching call if not yet done

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Southeast: May 14th Dayton: May 22nd Northwest: May 23rd

Southwest: May 30th Northeast: June 3rd Central: June 4th

It takes a village…

The MOMS+ Project is funded by the Medicaid Technical Assistance and Policy Program (MEDTAPP) and administered by the Ohio Colleges of Medicine Government Resource Center. The views expressed in this meeting are solely those of the authors and do not represent the views of state or federal Medicaid programs.